Pityriasis alba homoeopathic management- a case report

Dr Athirakrishnan G.K

INTRODUCTION:

pityriasis alba (synonym: Pityriasis sicca faciei, Pityriasis alba faciei,Erythema streptogyneus,Impentigo furfuracea, Pityriasis simplex) occurring in childhood and adolescence .An individual lesion characterized by an oval,finescaly,flat and erythematous or hypopigmented macule or patch.The lesions are most frequently observed on face,trunk and extensor surface of arms and legs.

PREVALENCE:

The incidence 8.4% in Indian children.Seasonal variation exist with summer exacerbation and winter improvement.More than one third of children with atopic dermatitis are reported to experience pityriasis alba. The prevalence in general population is 1% but the prevalence in atopic individual is 3.2%.

AETIOLOGY

The aetilogy of pityriasis is not fully known

1. Increased incidence in individuals who bath excessively defined as showering over once daily.This could be infer that removal of normal epidermal defense and other natural protective substances from the skin surface make more prone to this condition.
2. Photosensitivity.peak incidence of this condition seen in age when children begin to do more outdoor activities.typical location of lesions is sun exposed areas, also prolonged sun exposure of several hours.thus melanocytes appers to be sensitive to sun in these patients
3. Propinobacterium acnes bacteria which live in hair follicles has been considered as a possible producer of a hypothetical depigmenting factors.pityriasis alba frequently noted in children with early comedonal and papular acne.
4. Secondary to post inflammatory changes.
5. .Low serum levels of zinc is associated with Pityriasis Alba.Zinc is found in human skin with a concentration in dermis and epidermis.

CLINICAL FEATURES

• Clinical features is noted in children over 5 years to early adolescence in both girls and boys. The condition resolve with increased pubertal sebum production.
• The condition begin as a pale pink or light brown macule with very indistinct margins but often appears suddenly with decreased pigmentation. Macule vary from 5 to 30 mm or larger,color varies from ivory to light pink.
• Pityriasis Alba is characterized by area of pigmentation which is superficial,lightly scaling,circinate or ovate in shape.in some cases it shows irregular borders. The borders are quite distinct particularly if the Achromia occurs in deeply pigmented skin.

The lesion is generally limited to the cheeks,perioral area,forehead,trunk and proximal arms, and less frequently on legs.

DIFFERENTIAL DIAGNOSIS

• Atopic dermatitis
• Vitiligo
• Tineaversicolor
• Tineacorporis
• Pityriasis mosaicism.
• Mycosis fungoides

Wood lamp examination help to distinguish pityriasis alba from pityriasis versicolor.(potassium hydroxide) shows spores and hyphae in pityriasis versicolor  not in pityriasis alba.

GENERAL MANAGEMENT

It is self limiting condition and not dangerous also. A clinician should recommend the measure to limit the individual exposure to etiological factors like sun exposure,regular use of sunscreen,hot water bath.

HOMOEOPATHIC  MANAGEMENT

Rubrics in Murphy repertory

Skin: skin-pityriasis alba: agar,anac,aranix,argmet,ars,arsI,bac,berba,calc,carbac,caul,,colch,eryth,flac,graph,kaliars,kalibr,mang,merc,mercpr,mez,natar,natm,olnd,phos,phyt,ppm,psor,sep,sil,staph,sulac,sulph,tell,thuja,toxo

Rubrics in Boericke repertory

Skin-Pityriasis(dermatitisexfoliativa)-ars,arsiod,bac,berbaq,calcc,carbac,colch,flourac,graph,kaliars,mangac,merc,mez,natars,phos,sep,staph,sul,suliod,sulphac,tellur,tereb,thyr

Skin-Spots,white-graph,sul

Face-Eruptions–scales-ars,euphorbia

HOMEOPATHIC THERAPEUTICS

ARSENIC ALB

• Skin is dry,rough,scaly,dirty,shriveled,skin is like parchment.
• Eruptions,papular,dry,rough,scaly worse cold scratching.
• Skin eruption is alternate with asthma or internal disorders
• Hot and violent burning of skin
• Complaint that return annually
• Gradual loss of weight from impaired nutrition.
• chilly patient.

ARSENIC IODATUM

• Skin is dry scaly ithching
• Marked exfoliation of in large scales leavinga raw exudating surface
• Aggravation from washing

BACILINUM

• Tubercular diathesis
• The action is rapid and good result ought to be seen soon.no need of repetation.
• Aggravation at night

BERBERIS AQUIFOLIUM

• For chronic skin disease
• pityriasis
• Face is waxy yellowish white
• Pinched expression of face
• It affects the skin become dry,rough, scaly
• It should be given in mother tincture rather than giving in material doses.

KALI CHLOR

• Cold,discolored chocolate tint.itching military or papular eruption
• Small purple macule on forearm.

NATRUM MUR

• The skin is not well supplied with blood only slightly elastic
• Dry eruption.skin may be dry or many produce thick skin.
• Face is oily,shiny,as if greased.the complexion is pale yellow earty.
• Ailments from sunlight
• Dryness prevails
• Nutrition is greatly impaired in children’s.they are thin particularly about neck.

PSORINUM

• The patient dreads to be washed.
• The skin over the body especially of the face looks filthy though it has been well washed
• A dingy, dirty, foul look as if covered with dirt
• Skin become rough and scaly
• Many complaints of the skin are worse from bathing and from warmth of bed
• The skin itches when warmth of bed
• The eruption goes on spreads
• Offensiveness of discahrges

SEPIA

• Spots on skin.ringworm like eruption every spring.brown spots, letter like spots on the skin.
• Rawness of skin.
• Sepia establish a progressing emaciation of the bodyamd skin become wrinkled
• A child looks like a shriveled dried up old person
• Hyperhydrosis
• Itching not relieved by scratching

SULPHUR

• Skin it lacks a fresh smooth appearnce, but always dirty red,
• Sensitive towards cold water and cold air
• skin is rough and unhealthy.
• Secondary infections of all the skin type.
• Increased sweating occurs,the emanations from the skin and sweat are offensive and washing aggravation.
• Keratoplastic effect leads to dirty, sclay, dry, hard, fiasured skin.
• Uncleaniness as a child with unkempt hair.
• Generally secretions of sulphur is offensive, acrid and excoriating but still the sulphur patient is sensitive to all disagreeable odors even from his own body. This is an exception to his indiffernce to his own body and his environment.

CASE REPORT

10 year old boy came to the outpatient department of government homoeopathic medical college and hospital bangalore.presented with complaint of white discoloration over the right cheek since 2 months.

Details of presenting complaints

Child was apparently healthy till the last 2 months.gradually started with complaints of single white spot on the right cheek.later it spreads all over the right cheek.

It turns light pinkish when exposed to sunlight.

It is also asssociated with dryness of skin

Negative history:No history of bleeding, itching, erythema, redness, fever, allergy

Past history:Nothing significant

Allergic history:Not allergic to any irritants

Family history:All family members are healthy

Mentals

Irritable

Obstinate

Timid

Physical generals

• Appetite:Adequate
• Thirst:1 liter per day
• Bowel:regular
• Bladder:4-5 times per day
• Desire:idli
• Aversion:fatty foods
• Thermals:chilly
• Perspiration:increased
• Sleep:sound sleep

Clinical examnation findings

Inspection:hypopigmted spots.21 small spots over right cheek

Palpation:it measures about 1´1 cm.drynesspresent.smooth oval in shape.no elevated margins

Totality of symptoms

• Irritable
• Obstinate
• Timid
• Desire for idli
• Aversion to fatty foods
• Hypopigmented spots over right face

Evaluation of symptoms

Mental generals-

• timid
• obstinate
• irritable
• physical generals
• desire for idli
• aversion to fatty foods
• characteristic particulars
• hypopigmented patch over the cheek

Reportorial totality

• Mind-irritability-childen in
• Mind-obstinate-children
• Mind-timidity-children in-children towards other
• Generals-food and drinks-aversion-fatty foods
• Generals-food and drinks-idli-desire
• Face -discoloration-white spots

Prescription

Silicea 200

Figure 1 BEFORE

Figure 2 AFTER

Follow up

Date	Symptoms	Prescription
24/8/21	White spots reduced to 15. dryness reduced irritability reduced	Sl
15/11/21	White spots reduced to 12	Sl

Conclusion
This case report of pityriasis alba suggest homoeopathy has a promising role in treatment.The importance of repertorization in selection of  individualized remedy has s crucial role for the successful treatment. Also general management plays an important role in prevent in further recurrance

Declaration of patient consent

Patient consent and assent was taken for images and clinical indormation to be repoted for this article.

Conflict of intrest:Nil

REFERENCE

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4. Leeser otto, text book of Homoeopathic materia medica
5. PhathakSR,Materia medica of homoeopathic medicines
6. B William,pocket manual of homoeopathic material medica and repertory
7. Kent J T,lectures of homeopathic material medica
8. B dale,pityriasis alba a form of atopic dermatitis a preliminary report. https://jamanetwork.com/journals/jamadermatology/article-abstract/526758
9. L richie, pityriasis alba, dermatology and pediatrics, UMDNJ-New jersey medical school
10. M Fathima,AkiEssam,Awalid,zin has a role in pathogenesis of pityriasis alba,Indian journal of pediatric dermatology 2020.
11. B Craig,pityriasis alba a condition with possibly multiple etiologies,the open dermatological journal 2009

Dr Athirakrishnan G K
MD part 1 paediatrics
Under the guidance of Dr.Muddassir M Mulla
Associate Professor Department of Paediatrics
Government  Homoeopathic Medical College and Hospital,Bangalore